The over-the-Thanksgiving-weekend announcement from the World Health Organization about the potential for an avian flu pandemic is distressing. One WHO regional director (Dr. Shigeru Omi) said yesterday that a pandemic of avian flu could kill 50 million worldwide and as many as 100 million in a worst case scenario.
WHO officials in Geneva later said they did not know what research Omi used to arrive at his estimate, nor did they know why he believed a pandemic is likely. The NY Times quoted WHO spokesperson Dick Thompson: "WHO is trying to raise concern because we're concerned, but WHO is not trying to scare the planet."
Well guess what just may have happened to anyone following the story?
Klaus Stohr, WHO's influenza expert, told the Times, "The numbers [estimating deaths from avian flu] are all over the place." He added that Omi's estimate is "unscientific, unjustified and an inaccurate extrapolation from the current situation."
Journalists are often blamed for sensationalism and for failing to give proper context. This WHO adventure shouts out the need for better coordination, context and communication from anyone representing the international public health agency.
CORRECTION -- December 2: Dr. Stohr did not say that Shigeru Omi's estimate was "unscientific, unjustified and an inaccurate extrapolation from the current situation." He said that about an estimate attributed to Henry L. Niman, a Pittsburgh researcher. The Times wrote that Niman said "the death toll could in theory exceed a billion people if the disease were to spread rapidly among people with little if any reduction in current mortality rates." I apologize for linking Stohr's criticism to the wrong person.
I've saved this "fun with numbers" quote for a long time:
"Is 2.2% different than 0.6%?"
-- Dr. Randall Whitcomb, Warner-Lambert's vice president for diabetes research in 1996, explaining why the company told the FDA that liver injuries for patients taking Rezulin mirrored those in patients taking placebos during clinical trials. In the trials, 2.2% of Rezulin patients suffered liver damage, compared to 0.6% of placebo patients. (LA Times Sunday March 11, 2001)
Now let's fast forward to the CDC's revelation that it may have inflated the number of deaths related to obesity by tens of thousands because of statistical errors. The estimates appeared in a widely-cited article in the Journal of the American Medical Association, stating that obesity is gaining rapidly on tobacco as the leading cause of preventable death. Harvard's George Blackburn is quoted by USA Today saying, "Focusing on this one number is silly."
Is it?
Stanton Glantz of UCSF says in the NY Times, "The kind of policies one would develop for something that is killing about as many people as tobacco or a quarter as many people as tobacco are very different." The Washington Post quotes an analyst for the Center for Consumer Freedom: "A full investigation into the obesity death tally will reveal multiple flaws that seriously overstate the obesity problem and is leading to knee-jerk policymaking and litigation." (Of course, the Center is a "coalition of restaurants, food companies, and consumers working together to promote personal responsibility and protect consumer choices.")
The Wall Street Journal reported that CDC Director Julie Gerberding "conceded that the views of dissenting scientists hadn't been properly heeded" prior to the release of the report.
"I regret that the internal scientific concerns didn't come to light before the paper was published," Dr. Gerberding said. Of the agency's clearance process, she said, "We're going to fix it."
Good. Public policy must be based on statistically-sound data.
The Boston Herald reports that the head of the Novartis drug company warns that his company "could cut the supply of cheap drugs it sells to Canada in an attempt to stem the flow of those meds to bargain-hunting U.S. citizens."
"Why should we deliver quantities far higher than are needed in Canada,'' the drug honco said, in a speech to Boston College's Chief Executives Club.
Among the questions Americans might ask:
1. Why should we have to go to Canada to get cheaper drugs?
2. Why does all drug cost discussion seem to flow through Canada?
3. Why are Americans subsidizing the rest of the world's drug use?
One person recently asked me, "Why not a new Boston Tea Party? Just make it drugs this time."
The Wall Street Journal reports that a researcher who questioned the safety of the painkiller drug Bextra was removed by the FDA from an advisory panel that will review Bextra and similar drugs.
Dr. Curt Furberg said, "They'd said because I had taken a public position, I was disinvited."
Furberg was quoted in earlier news coverage that he found that patients taking Bextra might be at higher risk for heart attack or stroke.
Shouldn't we be applauding such openness and early disclosure rather than penalizing it? Especially on the heels of the Vioxx withdrawal, when evidence of harm had apparently been ignored or stifled for years?
From Jake's Comedy Corner blog (http://jakejakeny.blogspot.com/):
The good news is doctors say they've created a pill that's guaranteed to help you lose weight and stop smoking. The bad news is the pill is called "cyanide."
Do newspaper business pages have different editorial standards than the rest of the paper? Does evidence and balance matter less on the business page?
The (Minneapolis) Star Tribune had a massive story on D1 of the Sunday business section, complete with color art, explaining that "a simple device that encases the heart may offer a new tool to combat" heart failure. The device, a mesh-like sock, is made by a local company. The results of a 300-patient clinical trial were going to be (and were) released that day at the American Heart Association's annual meeting. The story did not have one comment from an independent medical source. But it did promote the company's "bullish" attitude about "the future of their unsual device as well as the company's prospects."
Then Monday's Star Tribune had another story, announcing, again, that the trial results were, indeed, released. The sock group was compared with a non-sock group of patients. The sock group scored better in "improvement" (not defined).
There was no mention of complication rates. There was no discussion of whether the results were statistically significant, or whether they could have been due to chance. But this is a hometown newspaper writing about a hometown company.
The Wall Street Journal also reported on the sock study, but pointed out that the "sock didn't lead to a significant improvement in ejection fraction, the percent of blood that is pumped out of the left ventricle during a beat and a widely used measure of the strength of the heart."
You've probably seen this before and will see it again: it may be too easy for hometown companies to get favorable coverage and it may not be in the best interests of readers (or patients). There was also no mention of costs, which is almost unthinkable in today's critical health care environment. The device is not yet approved by the FDA.
Jane Bryant Quinn's column in the Nov. 8 Newsweek is a sobering reflection on health policy issues that attracted too little attention in this week's election.
"Big Medicine holds enough power to beat down true reform," she writes. "You can still be spooked by phrases like 'government-run health care,' even though that defines Medicare, which you want more of."
She questions whether the U-S will attempt a fundamental fix in the next Congress. "Nah," she answers. "Too many rich, corporate players have a stake in the status quo. Princeton's (economist Uwe) Reinhardt distills our chosen policy this way: the suffering of a few million Americans, while regrettable, is a price well worth paying for fine coverage for the rest of us...The healthy find private policies, the sick get kicked out. That's the American Way."
National Public Radio reported that nine out of 10 U.S. voters said they were worried about the cost of health care (Montagne/Williams, "Morning Edition," NPR, 11/3).
That may be the only mandate in this election. What will a second Bush administration do on health care?
The Wall Street Journal reports that internal e-mails, marketing documents and interviews with outside scientists who questioned the safety of the Merck arthritis drug Vioxx indicate that the company "fought forcefully for years to keep safety concerns from destroying the drug's commercial prospects." The Journal reports that it examined internal e-mails that show Merck officials discussed the increased cardiovascular-related risks related to Vioxx and proposed to design studies that would "minimize the unflattering comparison" with less-expensive, older pain medications.
Meantime, the Public Citizen Health Research Group has written the FDA citing 29 cases of kidney problems associated with AstraZeneca's cholesterol-lowering drug, Crestor, the AP/Hartford Courant reports.